Sunday, February 6, 2011

On vulnerability

Don’t close the door, please! She pleads.I am clausterphobic.

The voice comes from the tiny blonde woman sitting in a corner of the room. Her soft wet eyes look up and meet mine. She seems to be shrinking before my eyes, like Alice in Wonderland or a wilting flower in one of those sped up films.

Two thoughts occur to me.

First is that I too don’t like closing doors, but for a different less generous reason. The second is that someone, somewhere along this woman’s life has messed her up. Now, she can’t even have the door to this room closed.

I ponder for a second the herculean task of our lives: to set straight what has happened to us, to work our way through it. And if we don’t or somehow can't, that mind of ours will do it for us.Panic attacks. Somatization. Clausterphobia.All kinds of unreasonable things.

I leave the door open.

I have already reviewed her chart. I do this to save time, inaccuracies, embarressment.In 2009 she was found to have a lung mass on xray. The CAT scan had diagnosed Bronchogenic carcinoma. She subsequently refused any further investigation or treatment.

She looks up at me.Quitely.There is something about her that at an earlier time in my life I would have called ‘mousy’, like a water rat coming up for air, scraggly and wet.

We talk about why she is here today.

Coughing - worse for the past week, but really it had been going on for weeks; associated with weight loss, but without fever.She adds that she hasn’t gone to work all of that week. For this woman, I imagine this is a big deal.

She is cachectic. Given her story, I know that this is really bad.

I sit next to her on the bed and gently help her lift her sweater. I notice her hair is a shiny highlighted blond.I will be doing an Xray so this feels like just going through the motions. My clinical skills are sadly going to extinction.

'I was afraid', is her answer. Why hadn’t she gone through with the bronchial washings 2 yrs ago?

She still smokes and I think I understand why.

‘Is it possible this is just a lung infection?’she asks. This isn't suicide by neglect. She has the will to live.

Her right upper and lower lungs are filled with something that gives them a white appearance on the xray – it could be fluid or more likely infiltration by a mass or by infection, or both.

‘It is possible. It could be an infection.’.She's right, it could be. Perhaps, an infection over and above the underlying problem.

'I can admit you to hospital', I offer. ‘No. I want to go home.’ was the reply. I don't push.

‘Make sure you come back for the CAT scan tomorrow.’. We negotiate. It's the doughnut, not the tube. The doughnut is okay.

She's stoic, containing her grief with dignity. She is protecting a vulnerable child.